12100090CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18880 HOMESTEAD RD I CONTRACTOR: ICOM MECHANICAL INC I PERMIT NO: 12100090
OWNER'S NAME: CUPERTINO OFFICE PARTNERS LLC 1477 BURKE ST 1 DATE ISSUED: 10/10/2012
OWNER'S PHONE: 4089748221 I SAN JOSE, CA 95112 PHONE NO: (408)792-2292 I
❑ LICENSED�i,
CONTRACTOR'S DECLARATION
License Class. C 66 / Lic./#� geR'6 Z-'ji
Contractor-1l6/V( /7ti'lCli'iUatE" �f1. /c�• fZ�
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. ditionall licant understands and will comply
with all non -points regu ons p e upertino Municipal Code, Section
9.18.
Signature Date �0,
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB r—
MECH r- RESIDENTIAL r- COMMERCIAL F,
JOB DESCRIPTION: MODIFICATION TO EXISTING HVAC SYSTEM TO ADD
(5)NEW
VAV'S AND RE -DUCT (4)EXISTING VAV'S
Sq. Ft Floor Area: I Valuation: $60000
APN Number: 31609037.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST (CALLED INSPECTION.
Issued by: Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain corgpliance w4b4kp,,qupertino Municipal Code, Chapter 9.12 and the
Health & ety C_qd , Sec on 25505, 25533, and 25534.
Ownej�an thoed a�
/rj" y Date. el0 . /t;. / 2 -
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed Professional
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: Q
PERMIT #
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR: LCA
BUSINESS LICENSE # 7.($'k3n
ADDRESS: -) W
CITY/ZIPCODE: qi ,--
*Our municipal code requires alf businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY PECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCON CTO E OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Q, - 2._._
Signatu a Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 18880 Homestead Road
DATE: 10/10/2012
REVIEWED BY: Sean
UNITS
APN:
BP#:
*VALUATION: 1$60,000
PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
#
PENTAMATION
PERMIT TYPE: FURN/A
WORK
Modification to existing HVAC system to add 5 new VAV's and re -duct 4 existing VAV's.
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
llhonb. Plan Check
QTY
UNITS
BP FEES
VAV Boxes
1 MCRAA
(liber Elee. Insp.
5
#
$665
Permit .Fee:
PME Unit Fee:
$665.00
PME Permit Fee:
$311.00
Consitzrction :Tcax:
Administrative Fee: ]ADMIN
$42.00
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: 1TRAVDOC
$665.00
Strong Motion Fee: IBSEISMICO
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information available and are onlv an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff.' //1 /12)
Mech. Plan Check0.0 hrs $0.00
llhonb. Plan Check
Elec..Plan Check
Mech. Permit Fee: IMPERMIT
Plumb. P< F,,
Other Mech. Insp. 2.0 hrs $45.00
Other Plumb Insp.El
(liber Elee. Insp.
Mech. Insp. Fee: IMECHINSP $266.001
Fc c,
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information available and are onlv an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff.' //1 /12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check:
$0.00
Permit .Fee:
PME Unit Fee:
$665.00
PME Permit Fee:
$311.00
Consitzrction :Tcax:
Administrative Fee: ]ADMIN
$42.00
Work Without Permit? 0 Yes 0 No
$0.00
;iE,��rrlc��cll'/u�t�lirr< I•cc�s:
Travel Documentation Fee: 1TRAVDOC
$45.00
Strong Motion Fee: IBSEISMICO
$12.60
Select an Administrative Item
BId4J Stds Commission Fee: 1BCBSC
$3.00
SUBTOTALS:
$1,078.60
$0.00 TOTAL FEE:
$1,078.60
Revised: 10/01/2012
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building Mcuoertino.org
[:1 PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
MEP
MISC
PROJECT ADDRESS
APN #
OWNERNAMEZ
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PHONE <�
E-MAIL
STREET ADDRESS A �
'!�
/ITTYY, SjATE, ZIP
FAX
CONTACT NAME
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PHONE
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E -MAI
STREET ADDRESS
CITY, STAT4g, � �n Z-
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FAX
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR 1:1 CONTRACTOR AGENT l ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC # ,'
Q
COMPANY NAME
E-MAIL
FAX
STREET ADDRESSCITY,
STATE, ZIPC� r '- '"-1 ZtioR
PHONE
'7172-2-2-1 L_
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
PROJECT IN WILDLAND ❑ YES
PROJECT IN ❑ YES
IS THE BLDG AN ❑ YES
BUILDING: OMMERCIAL
URBAN INTERFACE AREA NO
FLOOD ZONE ❑ NO
EICHLER HOME? X10
DESCRIPTION OF WORK
nDrprau
/th I 'TD
TOTAL VALUATION:
RECEIVED BY:
By my signature below, I certify to each of the w' I amt
rop Try owner or authorized agent to act on the property owner's behalf. I have read this
-r
application and the information I have prov' I orrect. I ha e
d the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil ' con cti4M. I a
rize representatives of Cupertino to enter thea ve-identified property for inspection purposes.
Signature of ApplicanUAgent: `�
Date: ��/` /Gh %�� 1-7
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
W
OVER -THE COUNTER
a
❑ EXPRESS
U
x
❑ STANDARD
zU
a
❑ LARGE
0.
❑ MAJOR
MEPMiscApp 2011.doc revised 06/21/11